The Existence, Functionality, and Utilization of Liver Cancer Registries in Sub-Saharan Africa: A Scoping Review

Abstract

Background: In Sub-Saharan Africa (SSA), liver cancer is the 5th most diagnosed and 4th most deadly cancer, with 46,000 cases and a 93% mortality rate. Preventable risk factors, including chronic Hepatitis B virus infection is the primary cause of hepatocellular carcinoma (HCC), which is the most frequent type of liver cancer. The administration of the Hepatitis B virus (HBV) birth dose vaccination is essential for preventing perinatal transmission of the virus and preventing chronic Hepatitis B infection. The WHO has established a target of obtaining 90% coverage for both the hepatitis B birth dose vaccine and the conventional three-dose baby vaccination series to eliminate hepatitis B. HCC is a highly fatal disease globally with the burden compounded in SSA by low HBV vaccination rates, late diagnosis, and limited access to care. Strengthening cancer registries is vital for clearly defining liver cancer burden, and for prioritising interventions and providing measurable targets to track effectiveness of strategies on disease burden reduction. Objective: Define the existence, functionality, and utilisation of liver cancer registries in SSA and describe the adherence to existing hepatitis B vaccine recommendations in SSA. Design: This scoping review adhered to the updated 2020 framework described in the Joanna Briggs Institute Manual for Evidence Synthesis (JBIMES) for the composition of scoping reviews. Data sources: Employing the inclusion criteria, PubMed, Google Scholar, Google searches, African Cancer Registry Network (AFCRN) , International Agency for Research on Cancer (IARC), World Health Organisation (WHO), Health Ministry websites, and grey literature. Information was requested via a questionnaire to every cancer registry in the SSA found during the search. Results: Two hundred and six of 2733 studies were included. Three cancer registries participated in the questionnaire, which further consolidated findings for the 3 cancer registries. The data suggest that 77 cancer registries in 37 Sub-Saharan African countries report liver cancer. Thirteen SSA countries lacked liver cancer registry data. Of the 77 cancer registries, 56 are population-based, 18 are hospital-based, and 3 are pathology-based. South Africa is the sole nation with a policy regulating the National Cancer Registry for cancer registration, whereas other countries lack such a framework. Healthcare facilities house most cancer registries. Due to understaffing and financial constraints, the majority of registries employ a director or registrar. All SSA nations have included Hepatitis B immunisation in 2 their Expanded Programme on Immunisation in different schedules, with 16 having included birth doses. One nation has achieved the WHO birth dose coverage goal of ≥90%, while 13 nations have attained the third dosage target coverage of ≥90%. Conclusions: African cancer registries face access, financing, obsolete data, and few monitoring tools, making cancer surveillance difficult. SSA and East Asia account for approximately 80% of hepatocellular carcinoma cases, making birth-dose hepatitis B vaccine, immunisation, and liver cancer screening essential. Taiwan's experience shows that immunisation and aflatoxin management may dramatically decrease HCC, emphasising the necessity for continental stakeholder cooperation.